Saturday, July 9, 2011

Concluding Thoughts from Week Two

Our professor, Dr. Ruth Ann Belknap, posed a question for our journals this week: Where have you seen cultural humility this week? None of us were too familiar with this phrase, because it used to be termed “cultural competence”. She explained that when a difference in cultures is recognized, humility and modesty is needed to step back and respect the other culture. Having been in Peru for three weeks now, there have been several examples of this. Peruvians are friendly people, greeting everyone with a hug and a kiss. They are significantly more open about breastfeeding, something kept relatively private in the States. But this week, I started to think of this term on a much larger scale.

Quite frequently, we hear unbelievable things about the healthcare system here. In interviewing the women’s group, we heard some shocking stories. One woman’s husband had been in a work accident and had shards of glass stuck in his back. Of course, insurance covered nothing, a typical situation for many people here in Peru. Initially when they visited the ER, they took out what was visible and rushed him out of the ER. They wanted him to go home as quickly as possible because doctors here simply do not want to be responsible for anything that might go wrong. Ten years later, this man still has shards of glass in his back because there is no care or money to fix it. This is the reason that people here turn to natural medicines and methods. They will avoid the healthcare at all costs.

It’s hard to be silent when a story like that creates so much anger. However, my biggest challenge this week was in the hospice. I always had difficulty with the pressure ulcers; those kinds of wounds would shock even the most experienced nurse. But yesterday, a new patient was admitted, a 31-year-old woman with terminal sarcoma. What lies under her bandages rocked me to my core. We don’t know what happened when she tried treatment down in Lima, but it appears that they tried to scoop the tumor out of her leg. She has an open wound that is the size of my face on the outer side of her thigh. Her skin is completely gone, and she bleeds ceaselessly. She has full visibility of not only this wound, but also the three baseball sized tumors that jut out of her groin. The worst part about this is not the grotesque appearance of her leg or the amount of time it took to stop her bleeding and clean the wound. It’s that the doctors and nurses here refuse to tell her she has terminal cancer.

It’s so hard to not question this, especially when the woman is already in the hospice and clearly has a serious ailment. But, I suppose this is where humility falls into place. There is a time to step back, respect the culture, and just administer the best care possible for this woman’s remaining time. Many Peruvians are very quiet about their own illnesses and the illnesses of others, and this part of the culture has been frustrating for our group. We come from a place where we want to know everything that’s wrong at all times, so we can treat it.

I’m slightly put at ease by the amount of educating we are doing during our time here in Piura. If we teach, then there is more widespread awareness of illness and the ways to prevent it. As the old proverb states, “Give a man a fish; you have fed him for today. Teach a man to fish; and you have fed him for a lifetime”. This rings true in places like this. On Monday, I will teach about nutrition and I am looking forward to contributing to illness prevention efforts. I’ll post more details about my teaching project soon!